What are the recommended first-line pharmacological treatments for erectile dysfunction according to current guidelines?

According to current clinical guidelines, phosphodiesterase-5 (PDE-5) inhibitors are recommended as the first-line pharmacological treatment for most men with erectile dysfunction, provided there are no contraindications ¹.

These drugs, which include sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®), and avanafil (Spedra®), work by increasing arterial blood flow to the penis, leading to smooth muscle relaxation, vasodilation, and erection ¹. PDE-5 inhibitors are generally effective, safe, and well-tolerated, with adverse effects typically being mild and self-limiting with continued use ¹.

While there are no significant differences in efficacy or adverse effect profiles between the different available PDE-5 inhibitors, their pharmacodynamic properties vary; for example, sildenafil, vardenafil, and avanafil are relatively short-acting, whereas tadalafil has a significantly longer half-life ¹. Treatment selection should be individualized based on the man's psychosocial risk factors, needs, and expectations ¹.

For NHS prescriptions, specific PDE-5 inhibitors like Viagra®, Cialis®, Levitra®, or Spedra® require endorsement with 'SLS' (Selected List Scheme), though generic sildenafil does not ¹.